1

TABLE OF CONTENTS

Acknowledgements ………………………………………………………………………………………………………………… 2

Introduction …………..……………………………………………………………………………………………………..………… 3

Group Protocol ………………………………………………………………………………………………………..……………… 4

Recommendations ………………………………………………………………………..…………………………………..…… 7

Overview of Worksheets & Handouts Recommended for Each Session……………………………….… 8

Session Outlines

1. What You Do Everyday Matters ………………………………………………………………..…………… 9

2. Reflecting on Balance in Everyday Life …….…………………………………..………………………. 12

3. Movement to Support Health & Wellbeing ……………………………………….…….…………… 14

4. Reflecting on My Home Environment ……………………………………….………………….……… 17

5. Social Support & Connection ……………………………………………………………………………..… 19

6. Maintaining Positive Change ………………………………………………………………………………… 21

Handouts and worksheets are included in the Appendix at the end of the manual.

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ACKNOWLEDGEMENTS

The writers would like to thank Dr. Lynn Cockburn a registered occupational therapist

for her supervision throughout the clinical placement. As well, Heather Campbell the Manager

of Senior’s Support Services and Renee Wetselaar the Executive Director at St. Matthew’s

House, Brenda Silverthorne the Community Development Coordinator of CityHousing Hamilton,

and Laurie Perrett the director of clinical education at McMaster University. Also, the St.

Matthew’s House team and CityHousing team for their ongoing support.

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INTRODUCTION

This program manual was developed by two second year occupational therapy students completing a role-emerging Level 3B fieldwork placement in a community setting during the summer of 2020. Coping with COVID-19 was run as a 5-week pilot program in a large social housing residence for seniors in downtown Hamilton, Ontario. This population faces a number of occupational issues that have been exacerbated by the coronavirus pandemic: social isolation, occupational deprivation, food insecurity, mobility issues, poverty, limited access to reliable information regarding the pandemic, and more.

For many of us, the coronavirus pandemic has drastically reduced opportunities for occupational engagement as we spend more time at home to protect ourselves and our communities (Larivière, 2020). This can lead to negative impacts on health and wellbeing, which may be intensified for older adults with limited access to resources and social supports. The group sessions outlined in this manual aim to address some of the challenges associated with the coronavirus pandemic, offer strategies for adapting to these challenges, and provide a safe and supportive space were participants can connect and share their experiences of occupational disruption. As Larivière (2020) points out, the impacts of the pandemic are not wholly negative. Although our activities have been greatly limited, the pandemic may also bring “an opportunity to rediscover that daily life has a richness that is often overlooked or minimized in ‘normal’ times” (Larivière, 2020, p. 1). In Coping with COVID-19, participants were encouraged to reflect on activities or activity patterns that enhance health and wellbeing, and others that are less supportive.

The Do Live Well health promotion framework formed the theoretical basis for our program. Because our group was not specific to any one diagnosis, disability, or occupational issue, Do Live Well was broad enough to be relevant to all group members (Moll et al., 2015). The key message of DLW, that “what you do everyday matters,” was useful in framing the role and scope of occupational therapy to group members who were not familiar with the profession. Rather than imposing a predetermined notion of healthy “balance” or “routine,” the framework affirms that there is no one correct or healthy way of spending your time. DLW offers the flexibility to address a variety of challenges relating to the disruptions and transitions experienced during and after the pandemic, while allowing participants to personalize the group experience to meet their own needs. Lastly, the consideration of “personal and social factors” in the framework was important for our population, as it allowed us to acknowledge that there are many health-influencing factors outside of the control of our participants, many of whom are experiencing poverty and other forms of socioeconomic inequality.

The session plans included in this manual have been revised from the original pilot based on our experiences facilitating the sessions as a well as feedback from group participants. While the program was developed specifically to address issues related to the coronavirus pandemic, it could easily be adapted to use in a variety of contexts. The activities and worksheets are useful in reflecting on changes to everyday life during any time of occupational disruption or transition, such as retirement, moving into a new home, the onset of illness or disability, and so on. We hope that this manual can inspire future programming, whether related to the pandemic or otherwise.

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GROUP PROTOCOL

Title: Coping with Covid-19 – Strategies to Support Health & Wellbeing

Purpose: Coping with COVID-19 is a 6-week group program designed to support older adults

adapting to occupational disruption related to the coronavirus pandemic. Strategies will

emphasize the use of meaningful activity to promote health and wellbeing when faced with

disruptions to everyday life.

Theoretical Framework: Do-Live-Well Framework

Do-Live-Well (DLW) is a Canadian health promotion framework created by Occupational

Therapists (OTs). The key message of the framework is “what you do everyday matters” (Moll

et al., 2015, p. 11). The framework has four key components: (1) dimensions of experience; (2)

activity patterns; (3) health and wellness outcomes; and (4) personal and social forces. The first

two components refer to what you do and how you do it, respectively. DLW posits that

participating in activities that provide a range of experiences in a way that is personally

meaningful contributes to positive outcomes in health and wellbeing. Intersecting personal and

social forces, including age, gender, race, dis(ability) and socioeconomic status, in addition to

physical, social, cultural and institutional environment impact opportunities and abilities to

participate in a range of meaningful activities. These factors in turn influence health and

wellness outcomes.

DLW is rooted in occupational therapy and occupational science literature and informed by

evidence demonstrating the relationship between activity, health and wellbeing (Moll et al.,

2015). By collaborating with interdisciplinary health care professionals, health promotion

experts, and members of the community, DLW was developed to be used across disciplines and

populations. Both clinicians and researchers have identified the relevance and resonance of the

DLW framework among older adults (J. Chahal & S. Moll, personal communication, July 23,

2020).

Although the DLW framework does not give specific recommendations for guiding practice,

Moll and colleagues (2015) state “the framework could be used to develop tools that prompt

reflection on patterns of time use and increase understanding of the opportunities and

challenges for participation,” particularly during times of occupational transition or disruption.

This program manual uses concepts from DLW to facilitate reflection on everyday activities and

routines. Additionally, each session introduces a strategy to support health and wellbeing

through integrating health promoting activities (e.g. relaxation, physical activity, social

connection), adjusting activity patterns (e.g. creating new habits or routines, increasing sense of

occupational balance) or adapting the environment (e.g. elf-assessment of home safety).

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Group Objectives:

1. Participants will appreciate the link between everyday activities, health, and wellbeing

as described in the Do-Live-Well model.

2. Participants will reflect on changes in everyday life (activities and routines) experienced

during the pandemic and identify impacts on health and wellbeing, whether positive

and/or negative.

3. Participants will be exposed to several different strategies to cope with occupational

disruption (e.g. developing a morning routine).

4. Participants will identify and implement at least one strategy learned in the group.

Method:

• The group is led by two facilitators (Student Occupational Therapists or other health

care professionals).

• Group sessions are led in a facilitative style (e.g. offering frequent opportunity for input

from participants on group content and process).

• Session designs are informed by Kolb’s (1984) theory of experiential learning. Kolb’s

adult learning cycle consists of four stages: experience, reflection, generalization, and

application (McNamara & Straathof, 2017). Coping with COVID-19 session outlines

roughly follow the template designed by McNamara and Straathof (2017) in their

program manual Coping Strategies to Promote Occupational Engagement and Recovery.

• Concepts from DLW Framework will be introduced using visual and verbal explanations.

Abstract concepts will be clarified using plain languages and examples to meet

participant abilities.

• Activities include brief lectures to explain new concepts or share information (maximum

five minutes), rich group discussions, independent or paired reflective activities,

relaxation and strength training exercises, worksheets, and goal setting.

• In addition to learning new strategies, the group also provides social support and

connection. Session outlines are flexible, and emphasis should be placed on promoting

positive interactions between participants over completing session activities.

Worksheets can be completed independently by participants at home if not finished

during sessions.

• Handouts and worksheets are provided to attendees at each session, in addition to any

other required materials (e.g. strength training exercise guide, pencil crayons).

• All participants receive a telephone call reminder approximately two hours before the

group session each week.

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Group Membership & Size:

• 4-8 participants

• Inclusion:

o Community dwelling older adults (60+)

• Exclusion:

o Severe mental illness and/or cognitive impairment if resulting in significant

disruptive behaviours or inability to participate in group activities.

• Support persons welcome to accompany participants

Outcome Criteria (See Appendix B for outcome measures):

• Pre-post rating scale regarding satisfaction with everyday life will be completed to track

progress

• Anonymous feedback survey during the final session

Materials:

• Chart paper and easel or whiteboard

• Markers

• Handouts and worksheets

• Pens and pencil crayons

• Tables and chairs

• Access to projector or TV monitor (optional)

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RECOMMENDATIONS FOR USING THIS MANUAL

Running Groups with Older Adults:

• Set group norms – to create a safe, open environment

• Be aware of participant abilities to assist in tailoring sessions as needed

o Differences in cognitive, social, literacy capabilities

o Socio-economic status: be aware of the cost of suggested activities, try to

provide materials as needed

• Be cognizant of hearing and vision impairments

o Can opt for more written handouts, chart paper as appropriate

o Using a pocket talker, having those with difficulty hearing seated closer to the

middle of the group or seated closely to the speaker

• Focus on both group content and process

o Observing group dynamics helps to facilitate participation from all group

members, appropriate seating, conflict management

• Less is more

o Aim for rich group discussion where possible, content is important but can also

be given in the form of handouts if time is limited

o Take advantage of the social connections that the group sessions provide

• Provide community resources for participants who need additional support

o Some participants may need additional support to make adaptations to their

lifestyle and/or environment. Provide information regarding community

resources (e.g. how to access community OT; falls prevention classes, etc.) to

enable participants to follow-up on what they have learned in the program

Using the Do-Live-Well Framework:

• Modify language as needed to meet the abilities of the audience

• Do not overwhelm individuals with introducing the entire framework at once, build on

concepts gradually to illustrate connections

• To support accessibility and knowledge translation, design sessions and activities

considering physical & mental health, literacy, communicative barriers, hearing and

vision impairments

• Consider applications beyond “Coping with COVID-19” as DLW is applicable in

addressing a variety of occupational disruptions and transitions

• DLW has developed a number of resources which are accessible on their website at no

cost: http://dolivewell.ca/tools-resources

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Overview of Worksheets & Handouts Recommended for Each Session:

Session Topic Resources

1 What You Do Everyday Matters

What You Do Everyday Matters! Worksheet Relaxation Techniques: https://www.therapistaid.com/worksheets/relaxation-techniques.pdf Relaxation Scale

2 Reflecting on Balance in

Everyday Life

Dimensions of Experience Worksheet Balance Wheel Worksheet

3 Movement to Support Health &

Wellbeing

Movement to Improve Health & Wellbeing Worksheet Chair Based Strength Exercises: http://allactive.co.uk/wp-content/uploads/2016/04/Chair-based-strength-exercises-no-equipment-AllActive-Information-Guide.pdf Canadian Physical Activity Guidelines For Older Adults—65 Years & Older: https://www.activeagingcanada.ca/assets/pdf/healthy-living/posters/Posters-CPAG/poster-1_CSEP-FINAL-ENG.pdf

4 Reflecting on My Home

Environment

Reflecting on My Home Environment Worksheet

5 Social Support & Connection

Social support (first page only): https://www.therapistaid.com/worksheets/social-support.pdf Circle of Support Worksheet

6 Maintaining Positive Change

Building New Habits: https://www.therapistaid.com/worksheets/building-new-habits.pdf Habit Plan: https://www.therapistaid.com/worksheets/habit-plan.pdf List of local resources (See Appendix C for example)

Copies of handouts and worksheets can be found in Appendix A. Additional resources can be accessed through provided links.

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Session 1: What You Do Everyday Matters!

Learning Point: Everyday activities and routines impact health and wellbeing. Learning Objective: Given guided relaxation exercise, participates will identify impact of activity on how they feel by rating level of relaxation before and after activity on 5-point Likert scale. Materials: Chart Paper/Whiteboard & Markers, Pre-Program Survey, Handouts; Progressive Muscle Relaxation Script OR TV Monitor/Projector (What You Do Everyday Matters! Relaxation Scale, Relaxation Techniques), Pens

Time Learning Stage Actions

15 minutes Introduction

• Orient participants to the room, where to sit

• Ask them to fill out survey before group gets started

• Facilitators introduce themselves, their role (e.g. Student OT), and overall purpose of

group

• Invite group to introduce themselves & share why they came to group

• Establish group norms collectively

• Say: Occupational therapists support people with their everyday activities. The purpose of

this session is to understand the connection between everyday activities and how we feel.

We will be talking about changes we’re experiencing in our everyday lives related to the

coronavirus pandemic and how we are coping with them. Many people have experienced

lots of changes to their everyday routine. Today we will be talking about those changes

and how they impact our health and well-being.

• Introduce Do-Live-Well. Say: Throughout this program, we will be referring to something

called “Do-Live-Well”. Do Live Well is a framework created by Canadian occupational

therapists to help us understand how our everyday activities impact health and wellbeing

(Moll et al., 2015)

10 minutes Warm-Up • Invite group members to share how their routines have changed during coronavirus

pandemic (Larivière, 2020)

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• Discussion questions:

o What has been going well for you? What has been more challenging?

o What activities have you started/continued/stopped?

o What do you miss doing from before?

o What have you been able to do that you didn't have time for before?

• Use chart paper to note participants response

10 minutes Experience

• Introduce Progressive Muscle Relaxation. Say: Now we will do an exercise to demonstrate

the link between what you do and how you feel. Many Canadians are experiencing

increased levels of stress and anxiety related to COVID-19. We are going to show you a

relaxation exercise that can help to manage these feelings. It is called Progressive Muscle

Relaxation (PMR). Completing relaxation exercises like PMR have many benefits to your

health and wellbeing, including decreased stress, anxiety, pain and fatigue. (Hassanpour-

Dehkordi & Jalali, 2016; McCallie, Blum & Hood, 2006).

• Before starting, ask participants to rate their current level of relaxation on the scale

provided (orient group members to Likert scale).

• Facilitator to read progressive muscle relaxation script; OR

• Play PMR video from YouTube

• Ask participants to rate their level or relaxation after PMR

5 minutes Reflection

• Discussion questions:

o How did that activity make you feel?

o Did you notice a change in your level of relaxation?

5 minutes Generalization

• Discussion questions:

o What types of activities in your everyday life impact how feel? o Do you notice that certain activities make you feel good (physically, mentally,

emotionally, spiritually) and others do not?

10 minutes Application • Orient to What You do Everyday Matters! worksheet and have group members complete

first line based on relaxation exercise.

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• Ask participants to pay attention to their everyday activities over the next week. Write down a few activities they do (or want to do) on the worksheet. Encourage them to identify how the activity impacts health and wellbeing, or how they feel (physically, mentally, emotionally, and spiritually) when engaging in that activity.

• Share Relaxation Techniques Handout

5 minutes Summary • Share one activity you will be doing over the next week

References

Hassanpour-Dehkordi, A., & Jalali, A. (2016). Effect of progressive muscle relaxation on the fatigue and quality of life among Iranian aging persons. Acta Medica Iranica, 430-436.

McCallie, M. S., Blum, C. M., & Hood, C. J. (2006). Progressive muscle relaxation. Journal of Human Behavior in the Social

Environment, 13(3), 51-66. Moll, S. E., Gewurtz, R. E., Krupa, T. M., Law, M. C., Lariviere, N., & Levasseur, M. (2015). “Do-Live-Well”: A Canadian framework for

promoting occupation, health, and well-being: «Vivez-Bien-Votre Vie»: un cadre de référence canadien pour promouvoir l’occupation, la santé et le bien-être. Canadian Journal of Occupational Therapy, 82(1), 9-23.

Statistics Canada. (2020). “Canadians' mental health during the COVID-19 pandemic.” The Daily. May 27. Statistics Canada catalogue

no. 11-001-X. p. 1-5. https://www150.statcan.gc.ca/n1/daily-quotidien/200527/dq200527b-eng.pdf (accessed August 28, 2020).

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Session 2: Reflecting on Balance in Everyday Life

Learning Point: Having a balanced range of experiences in everyday life has positive impacts on health and wellbeing (Moll et al., 2015). Learning Objective: Participants will reflect on balance in their current activity patterns and will identify one activity that could be modified to increase perceived sense of balance, as evidenced by completing the Balance Wheel Worksheet. Materials: Chart Paper/Whiteboard & Markers, Handouts (Dimensions of Experience, Balance Wheel), Pencil crayons, Pens

Time Learning

Stage Actions

10 minutes Intro

• Orient participants to the room, where to sit

• Review group norms.

• Invite participants to share what they noticed over the previous week about the connection

between activities, health and wellbeing.

• Introduce session theme: “At our first session, we discussed the link between activities, health

and wellbeing. This week, we are going to look more closely at our daily routines.”

5 minutes Warm-Up • Ask: What does “balance” mean to you in the context of your everyday life?

20 minutes Experience

• Say: Research has shown that participating in a range of different meaningful activities is

important for health and wellbeing (Moll et al., 2015). The Do-Live-Well framework groups

these activities into eight different “dimensions of experience.

• Orient participants to Dimensions of Experience worksheet.

• Introduce 3-4 dimensions of experience on flipchart/whiteboard and have the group generate

example of activities they do/have done/want to do for each dimension.

• Say: Now that we have talked about different experiences and activities, we would like to

introduce the concept of balance. Occupational balance refers to when you have the right

amount and level of variation between the things you do. A balanced lifestyle will look

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different for everyone, and that’s ok! (Moll et al., 2015; Wagman, Hakansson, & Bjorklund,

2012)

• Refer clients to Balance Wheel Activity worksheet and pencil crayons.

• Say: The purpose of this activity is to reflect on balance in our everyday lives. The worksheet

will help us to identify which dimensions are satisfying and which ones could use some

attention.

• Give 10 minutes to fill in worksheet.

5 minutes Reflection • Pair and Share:

o Say: Discuss your balance wheel with your neighbor.

5 minutes Generalizatio

n

• Pair and Share: o Say: Now, discuss with your partner how you could increase balance. You might identify

one Dimension where you are least satisfied.

10 minutes Application

• Say: Take a few minutes to think about one activity related to the dimension you identified. What could you change to increase satisfaction in that dimension (e.g. do more, do less, do differently)? Write down what you come up with. For example, if you were unsatisfied in Connecting with Others, you might think about increasing phone calls to friends or family.

• Give time for participants to write.

5 minutes Summary • Go around the room and share the activity change we would like to make over the next week.

References: Moll, S. E., Gewurtz, R. E., Krupa, T. M., Law, M. C., Lariviere, N., & Levasseur, M. (2015). “Do-Live-Well”: A Canadian framework for promoting occupation, health, and well-being: «Vivez-Bien-Votre Vie»: un cadre de référence canadien pour promouvoir l’occupation, la santé et le bien-être. Canadian Journal of Occupational Therapy, 82(1), 9-23. Wagman, P., Hakansson, C., & Bjorklund, A. (2012). Occupational balance as used in occupational therapy: A concept analysis. Scandinavian Journal of Occupational Therapy, 19, 322–327. doi:10.3109/11038128.2011.596219

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Session 3: Movement to Support Health & Well-being

Learning Point: Regular movement and physical activity contributes to positive outcomes in health and well-being. Learning Objective: Having participated in group movement activity, participants will identify how likely they are to incorporate movement/exercise/physical activity into everyday life as evidenced by completion of 5-point Likert scale. Materials: Chart Paper/Whiteboard & Markers, TV monitor/projector (optional), Handouts (Movement to Improve Health & Wellbeing, Chair Based Strength Exercises, Canadian Physical Activity Guidelines)

Time Learning

Stage Actions

10 minutes Intro

• Orient participants to the room, where to sit, hand sanitizer, masks • Review group norms. • Say: Last week we looked more closely at our daily routines to understand how we can optimize our

health and wellbeing through living a balanced lifestyle. • Invite participants to introduce themselves and share the change you made over the week • Introduce session theme: The theme of this week is movement to support health and wellbeing. We

will be talking about some of the benefits of movement (e.g. exercise, physical activity) and then doing some strength training exercises together.

5 minutes Warm-Up

• Discussion questions: o What types of movement and/or physical activity do you currently do? o What beliefs do you have about movement and/or exercise? o What makes exercising difficult?

20 minutes Experience

• Discuss benefits of physical activity (Taylor, 2014; Tremblay et al., 2011; Sherrington et al., 2020; Heinzel et al., 2015), referencing Movement handout:

o Improved ability to complete everyday activities o Improved mood o Reduced risk of falls o Improved cognitive function, reduced risk of developing dementia

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o Improved sleep quality o Improved bone density o Reduced risk of cardiovascular disease, stroke, some types of cancer, diabetes

• Review safety precautions (Panton & Loney, n.d.) • Warm-up Activity:

o Walk for 5 minutes at a moderate pace; OR o 5 minutes of light seated movements (e.g. arm circles; seated marching) OR; o Play a warm-up video from YouTube

• Seated Strength-Training exercises (15-20 mins): o Demonstrate 4-8 exercises from Chair Based Strength Exercises handout, group members

follow along; OR o Play an exercise video from YouTube

5 minutes Reflection

• Discussion questions: o How did the exercises feel? o What did you like and what didn’t you like?

5 minutes Generalization • Show the group a list of the DLW Dimensions of Experience (written on whiteboard or chart paper) • Discussion question:

o Which dimensions relate to movement/exercise/physical activity? (Can be more than one)

10 minutes Application

• Orient participants to Movement handout • Give time to fill in questions:

o How likely to incorporate physical activity into day to day life? (1-5 Likert scale) o Support/barriers to incorporating activity

5 minutes Summary • Go around the room and share how we plan to incorporate movement into our routine this week

References

All Active. (n.d.). Information guide: Your Health and Fitness, Chair-based strength exercises (no equipment). Retrieved from: http://allactive.co.uk/wp-content/uploads/2016/04/Chair-based-strength-exercises-no-equipment-AllActive- Information-Guide.pdf

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Heinzel, S., Lawrence, J. B., Kallies, G., Rapp, M. A., & Heissel, A. (2015). Using exercise to fight depression in older adults. GeroPsych. Panton, L. B. & Loney, B. S. (n.d.). Exercise for older adults: Health care provider edition. Retrieved from: http://file.lacounty.gov/SDSInter/dmh/216745_ExerciseforOlderAdultsHealthCareProviderManual.pdf Taylor, D. (2014). Physical activity is medicine for older adults. Postgraduate medical journal, 90(1059), 26-32. Tremblay, M. S., Warburton, D. E., Janssen, I., Paterson, D. H., Latimer, A. E., Rhodes, R. E., ... & Murumets, K. (2011). New Canadian physical activity guidelines. Applied physiology, nutrition, and metabolism, 36(1), 36-46. Sherrington, C., Fairhall, N., Wallbank, G., Tiedemann, A., Michaleff, Z. A., Howard, K., ... & Lamb, S. (2020). Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. British journal of sports medicine, 54(15), 885-891.

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Session 4: Reflecting on My Home Environment

Learning Point: Our environment impacts our ability to engage in meaningful activities, and in turn, our health and wellbeing (Powell et al., 2017). Learning Objective: Participants will reflect on home environment (e.g. apartment) and identify one thing that could be modified to increase home safety and/or ability to engage in meaningful activities. Materials: Chart Paper/Whiteboard & Markers, TV monitor/projector (optional), handouts (Reflecting on My Home Environment), pens

Time Learning

Stage Actions

10 minutes Introduction

• Orient participants to the room, where to sit, hand sanitizer, masks • Review group norms. • Invite participants to introduce themselves and share one type of movement (physical activity)

they did over the past week. • Introduce session topic: During our first 3 sessions, we’ve mostly focused on reflecting on

ourselves – our routines, habits, and goals. Today, we are going to shift our attention outwards to look at our environment.

5 minutes Warm-Up • Discussion questions:

o Ask: What does the word ‘environment’ mean to you?

20 minutes Experience

• Say: Occupational therapists often suggest changes clients can make to their environment to support them to do the activities they want to do or need to do. Your environment is everything around you – your apartment, the building, the community, and the city. In the Do-Live - Well model, factors in our environment are referred to as social forces.

• Prompt discussion about the ways in which our environment can function as a facilitator and a barrier to engaging in meaningful activities (Lawton, 1982).

o How does your environment support you or prevent you from doing the things you want to do?

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o Example: Elevators in the building: help facilitate attending the group for those who cannot use stairs; also function as a barrier to getting to the group on time when you must wait a long time to get on the elevator.

• Note facilitators/barriers on chart paper. • Say: For the rest of the session, we are going to focus on our home environment. Many things in

our home environment support our ability to do the things we want to do. However, some things in our home might also cause safety risks, which can reduce our ability to participate in meaningful activities. For example, some things in our home may increase our risk of trips or falls. Now, we are going to do an activity to look at things in the home that might cause you to trip or fall.

• Activity: o Project images of rooms with trip hazards onto monitor; OR o Hand out printed images of rooms. o Ask group members to identify potential hazards in images

5 minutes Reflection • Discussion Question

o Did you learn anything new from that activity?

5 minutes Generalization • Discussion Question:

o Can you identify anything in your own home that might cause you to trip or fall?

10 minutes Application • Orient participants to Reflecting on My Home Environment worksheet. • Give time to complete

5 minutes Summary • Share one change you would like to make to your home environment.

References Powell, J., Mackintosh, S., Bird, E., Ige, J., Garrett, H., & Roys, M. (2017). The role of home adaptations in improving later life. Centre for Ageing Better. https://uwe-repository.worktribe.com/output/878076/the-role-of-home-adaptations-in-improving-later- life Lawton, M. P. (1982). Competence, environmental press and the adaptation of older people. In M. P. Lawton, P. G. Windley, & T. O. Byerts (Eds.), Aging and the environment: Theoretical Approaches (pp. 33-59). New York: Springer.

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Session 5: Social Connectedness Learning Point: The types of social support, importance of social connectedness and its impact on well-being. Ways to connect with others will also be explored (in person, phone, virtually). Learning Objective: Participants will identify one way they will connect with others over the following week while following pandemic precautions as evidenced by completion of worksheet. Materials: Chart Paper/Whiteboard & Markers, Handouts (Social Support, How to Connect with Others)

Time Learning

Stage Actions

10 minutes Intro

• Orient participants to the room, where to sit, hand sanitizer, masks • Review group norms. • Invite participants to share if there has been any follow-up on changes regarding home safety they

have made around the apartment and any facilitators and any barriers they experienced planning or making this change.

• Introduce session topic: Today, we will be spending some time talking about social support and connection.

5 minutes Warm-up • Discussion Question:

o How has your social life changed during the pandemic?

10 minutes Experience

• Say: Connecting with others is one of the dimensions of experience described in the DLW model. When we connect with others, we both receive and provide social support. Social support, it includes the help provided by family, friends, groups or communities that fulfill different needs.”

• Work through handout on Social Support (use first page only): o Explain the benefits of social support (Holt-Lundstad, Smith, & Layton, 2010; Newman &

Zainal, 2020) o Facilitator can name and define the types of social support and ask participants to provide

examples - e.g. "Tangible support includes offering help to practical problems, such as

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helping someone with household chores such as cleaning. Can anyone think of other examples?”

o Review ways to build social support, again asking for participant input prior to sharing the information on the handout to elicit group discussion

5 minutes Reflection • Pair & Share:

o Discuss with your neighbour the types of support you have in your life

10 minutes Generalization • Orient to “Circle of Support” worksheet, explaining different levels • Give time to complete worksheet

10 minutes Application

• Go through How to Connect with Others Handout • Group members invited to set intention of trying 1 new way to connect with someone over next

week (ask to write down): o Introduce self to neighbour o Call a friend o Call a support line o Go online

10 minutes Summary • Go around the group and discuss potential plans for the week (e.g. “I will call my friend” “I will

introduce myself to my neighbour”)

References:

Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: a meta-analytic review. PLoS medicine, 7(7), e1000316. Newman, M. G., & Zainal, N. H. (2020). The value of maintaining social connections for mental health in older people. The Lancet Public Health, 5(1), e12-e13. Smith, M. L., Steinman, L. E., & Casey, E. A. (2020). Combatting Social Isolation among Older Adults in a Time of Physical Distancing: The COVID-19 Social Connectivity Paradox. Frontiers in Public Health, 8, 403.

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Session 6: Maintaining Positive Change Learning Point: There are a number of strategies you can use to help maintain positive lifestyle changes. Learning Objective: Having participated in discussion on changing habits, participants will create a plan to start/change one habit as evidenced by completion of Habit Plan worksheet. Materials: Chart Paper/Whiteboard & Markers, Handouts (Building New Habits, Habit Plan, Resource List)

Time Learning

Stage Actions

10 minutes Intro

• Orient participants to the room, where to sit, hand sanitizer, masks • Invite participants to introduce themselves and share if there has been any follow-up on

changes regarding connecting with others over the past week. As well, any facilitators and any barriers they experienced during these social interactions.

• Review group norms. Introduce session topic: As this is our last session, we will be spending our time focusing maintaining positive change in the future!

5 minutes Warm-Up • Ask: What comes to mind when you hear the word “change”?

15 minutes Experience

• Say: We hope you have all learned some new strategies in this group (highlight –routine, importance of physical activity, social supports, relaxation), and we want to support you to continue to use these strategies in your life after the group ends.

• Say: Let’s talk about change. There are certain things that can help you change and build a new habit, and there are also challenges to making a change.

• Go through handout on Building New Habits – invite each participant to read one point and expand into discussion and examples as appropriate. Write down examples on chart paper.

5 minutes Reflection

• Pair & Share: o With your neighbour, discuss one strategy from the list that you would find the most

helpful or be the most likely to use.

22

5 minutes Generalization

• Pair & Share: o Now think of one habit you would like to change. It might be something you learned in

this group – incorporating relaxation, socializing, remembering to wear your mask when around others, reducing clutter, going to bed at a certain time. Discuss with your partner how you would use the Habit Change strategy for that specific habit.

10 minutes Application • Explain Habit Plan worksheet • Complete worksheet independently

10 minutes Summary &

Program Wrap-up

• Go around circle and share the one (strategy, tool, idea, habit) from the group they will be most likely to use in the future.

• Thank participants for attending the group sessions and provide a way for them to follow-up if need be (e.g. facilitator contact information support worker in a retirement home)

• Share relevant community resources (see Appendix C for example). • Administer post-program survey and feedback form

References Arlinghaus, K. R., & Johnston, C. A. (2019). The Importance of Creating Habits and Routine. American journal of lifestyle medicine, 13(2), 142-144 Nemec, P. B., Swarbrick, M. A., & Merlo, D. M. (2015). The force of habit: Creating and sustaining a wellness lifestyle. Journal of psychosocial nursing and mental health services, 53(9), 24-30.

References

All Active. (n.d.). Information guide: Your Health and Fitness, Chair-based strength exercises (no equipment). Retrieved from: http://allactive.co.uk/wp-content/uploads/2016/04/Chair

based-strength-exercises-no-equipment-AllActive-Information-Guide.pdf Arlinghaus, K. R., & Johnston, C. A. (2019). The Importance of Creating Habits and Routine. American journal of lifestyle medicine, 13(2), 142-144 Hassanpour-Dehkordi, A., & Jalali, A. (2016). Effect of progressive muscle relaxation on the fatigue and quality of life among Iranian aging persons. Acta Medica Iranica, 430-436. Heinzel, S., Lawrence, J. B., Kallies, G., Rapp, M. A., & Heissel, A. (2015). Using exercise to fight depression in older adults. GeroPsych, 28(4), 149-162. Kolb, D. A. (1984) Experiential Learning, Englewood Cliffs, NJ.: Prentice Hall. Larivière, N. (2020). Occupational therapists’ contribution during this pandemic: supporting you in times of occupational disruption. Do-Live-Well. http://dolivewell.ca/wp- content/uploads/2020/05/larrivi%C3%A8re-2020-occupationnal-therapist-contribution- during-this-pandemic-supoporting-you-in-times-of-occupational-disruption.pdf Lawton, M. P. (1982). Competence, environmental press and the adaptation of older people. In M. P. Lawton, P. G. Windley, & T. O. Byerts (Eds.), Aging and the environment: Theoretical Approaches (pp. 33-59). New York: Springer. McCallie, M. S., Blum, C. M., & Hood, C. J. (2006). Progressive muscle relaxation. Journal of Human Behavior in the Social Environment, 13(3), 51-66. McNamara, M., & Straathof, T. (2017). Coping strategies to promote occupational engagement and recovery: a program manual for occupational therapists and other care providers. CAOT. Moll, S. E., Gewurtz, R. E., Krupa, T. M., Law, M. C., Lariviere, N., & Levasseur, M. (2015). “Do- Live-Well”: A Canadian framework for promoting occupation, health, and well-being: «Vivez-Bien-Votre Vie»: un cadre de référence canadien pour promouvoir l’occupation, la santé et le bien-être. Canadian Journal of Occupational Therapy, 82(1), 9-23. Nemec, P. B., Swarbrick, M. A., & Merlo, D. M. (2015). The force of habit: Creating and sustaining a wellness lifestyle. Journal of psychosocial nursing and mental health services, 53(9), 24-30.

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Panton, L. B. & Loney, B. S. (n.d.). Exercise for older adults: Health care provider edition. Retrieved from: http://file.lacounty.gov/SDSInter/dmh/216745_ExerciseforOlderAdultsHealthCareProvid erManual.pdf Powell, J., Mackintosh, S., Bird, E., Ige, J., Garrett, H., & Roys, M. (2017). The role of home adaptations in improving later life. Centre for Ageing Better. https://uwe- repository.worktribe.com/output/878076/the-role-of-home-adaptations-in-improving- later- life Sherrington, C., Fairhall, N., Wallbank, G., Tiedemann, A., Michaleff, Z. A., Howard, K., ... & Lamb, S. (2020). Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. British journal of sports medicine, 54(15), 885- 891. Statistics Canada. (2020). “Canadians' mental health during the COVID-19 pandemic.” The Daily. May 27. Statistics Canada catalogue no. 11-001-X. p. 1-5. https://www150.statcan.gc.ca/n1/daily-quotidien/200527/dq200527b-eng.pdf (accessed August 28, 2020). Taylor, D. (2014). Physical activity is medicine for older adults. Postgraduate medical journal, 90(1059), 26-32. Tremblay, M. S., Warburton, D. E., Janssen, I., Paterson, D. H., Latimer, A. E., Rhodes, R. E., ... & Murumets, K. (2011). New Canadian physical activity guidelines. Applied physiology, nutrition, and metabolism, 36(1), 36-46. Wagman, P., Hakansson, C., & Bjorklund, A. (2012). Occupational balance as used in occupational therapy: A concept analysis. Scandinavian Journal of Occupational Therapy, 19, 322–327. doi:10.3109/11038128.2011.596219

Appendix A

Worksheets & Handouts

Relaxation Scale

Circle level of relaxation:

Before tense 1 2 3 4 5 relaxed

After tense 1 2 3 4 5 relaxed

Relaxation Scale

Circle level of relaxation:

Before tense 1 2 3 4 5 relaxed

After tense 1 2 3 4 5 relaxed

Relaxation Scale

Circle level of relaxation:

Before tense 1 2 3 4 5 relaxed

After tense 1 2 3 4 5 relaxed

What You Do Everyday Matters!

Inman & Balakumar, 2020

(Moll et al., 2015)

Dimensions of Experience & Activity Patterns Health & Wellness Outcomes

How do they impact my health and wellness?

Hint: How do your everyday activities make you feel physically, mentally, emotionally, and spiritually?

1. 2. 3. 4. 5. 6.

What activities do I do?

Hint: Think about how you spend your time each day.

1. Relaxation exercise 2. 3. 4. 5. 6.

Inman & Balakumar, 2020 (Adapted from Moll et al., 2015)

Dimensions of Experience

Research has shown that having a range of different experiences in your day to day life has positive outcomes on health and wellbeing (Moll et al., 2015). The Do-Live-Well framework organizes experience into eight categories: 1. Activating your body, mind and senses: Activation can take many forms, from

physical exercise (activating one’s body) to completing crossword puzzles (activating one’s mind) to listening to music (activating one’s senses).

2. Connecting with others: Activities related to socializing, friendships, and relationships. Connecting may take many forms (face-to-face versus virtual) and involve a range of ‘‘others’’ (family, friends, neighbours, coworkers, acquaintances, and even animals).

3. Contributing to community and society: Getting involved in community groups, volunteering, and political engagement.

4. Taking care of yourself: Taking care of your physical, emotional, mental, and spiritual needs. May include a range of activities, such as exercising, eating well, taking medication, spending time with loved ones, and taking time to relax.

5. Building security/prosperity: Achieving financial and social security. Examples include managing your budget, securing safe housing, and taking care of your apartment.

6. Developing and expressing identity: Interests, preferences, values, personal strengths, culture and other characteristics make up your identity. Activities related to identity might include participating in cultural events, reflecting on your values, or spending time with people who share your identity.

7. Developing capabilities and potential: Gaining or improving skills, knowledge, and abilities. It involves challenging yourself and setting goals.

8. Experiencing pleasure and joy: Activities that bring experiences of enjoyment.

Inman & Balakumar, 2020 (Adapted from Moll et al., 2015)

Dimensions of Experience

Think of one or two activities that fit in each category. These could be things you are currently doing, things you have done in the past, or things you would like to try. It’s ok to leave some categories blank if they are less relevant to you.

Activating the mind body and senses:

1. ________________________

2. _________________________

Connecting with others:

1. _________________________

2. _________________________

Contributing to community:

1. _________________________

2. _________________________

Taking care of yourself

1. _________________________

2. _________________________

Building security/prosperity

1. _________________________

2. _________________________

Developing and expressing identity

1. _________________________

2. _________________________

Developing capabilities and potential

1. _________________________

2. _________________________

Experiencing pleasure and joy

1. _________________________

2. _________________________

Inman & Balakumar, 2020 (Adapted from Moll et al., 2015)

Balance Wheel Activity

Instructions: Colour in each section of the wheel based on your current level of satisfaction in each category. Put a star next to the category where you would most like to make a change.

Activating my mind and body

Building our prosperity and security

Experiencing pleasure and joy

Developing our capabilities and potential

Expressing our personal identity

Taking care of ourselves

Contributing to our community

Connecting with others

Movement to Improve Health & Well-Being

Benefits of Exercise

PHYSICAL

PSYCHOLOGICAL

Increases: • Strength to help maintain or increase

independence • Energy • Balance - may reduce risk of falls or

reduce severity of a fall • Ability to perform daily activity (combing

hair, getting dressed)

• Enhances mood • Improves quality of life & feelings

of well-being • Improves sleep • Decreases depression • Decreases stress

Safety First: • Activities inducing or increasing pain should be avoided • Feel tired or severe discomfort – slow down and take it easier • Before stretching, warm-up to increase heart rate and loosen up the muscles

o 5-10 minutes of walking or other light movement • Start slowly, progressively build up activity

____________________________________________________________________________________________________________________

How likely are you to add resistance exercises to your routine?

Very Unlikely 1 2 3 4 5 Very Likely

What supports me to incorporate physical activity into my routine?

What limits me with incorporating physical activity into my routine?

Panton, L. B. & Loney, B. S. (n.d.). Exercise for older adults: Health care provider edition. Retrieved from: http://file.lacounty.gov/SDSInter/dmh/216745_ExerciseforOlderAdultsHealthCareProviderManual.pdf

Inman & Balakumar, 2020

Reflecting on my Home Environment

Factors in our environment impact what we do and how we do it. In the Do-Live-Well model, these

factors are referred to as social forces. Use this worksheet to identify factors in your home

environment that support and/or detract from your health and wellbeing.

1. What about my home helps me participate in the activities that are important to me?

______________________________________________________________________________

______________________________________________________________________________

2. What about my home makes it challenging to participate in activities that are important to me?

______________________________________________________________________________

______________________________________________________________________________

3. Are there any changes I could make to my home environment to make it easier to do the

activities I want to do or need to do?

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Is it possible to make this change? (Circle One)

Yes No Not sure

Do I need help to make this change? (Circle One)

Yes No Not sure

4. List the steps needed to take to make this change (e.g. contact someone, purchase something,

get rid of clutter). Simple changes might only take one step, bigger changes might require

multiple steps to complete. Asking for help might be your first step.

• __________________________________________________________________

• __________________________________________________________________

• __________________________________________________________________

Inman & Balakumar, 2020

(Moll et al., 2015)

Connecting with Others: My Circle of Support

ME

Closest friends, family, and caregivers

People I interact with regularly (friends, acquaintances, pets,

service providers, etc.)

People I interact with occasionally (service providers, neighbours,

community members, etc.)

Inman & Balakumar, 2020

How to Build Connection with Others

“Connecting” with others (family, neighbours, pets) can be done face to face or virtually. The type and depth off the relationship can vary between people.

The quality and quantity of the connection can predict health and well-being, and research shows connecting with others is GOOD for you!

Recommendations to prevent spread of COVID-19 while socializing

• Continue to practice physical distancing whenever possible (stay 6 feet/2 metres away from others)

• Wear a mask when you are unable to physical distance

• Socializing outdoors is safer than indoors

• Practice good hand hygiene

• Avoid handshakes and hugs with people outside your close circle

Connecting in Person

• Spend time with others outdoors

• Introduce yourself to your neighbours

• Be a good listener – show interest in other people’s lives

• Respect the personal space of others (stay 6 feet/2 metres away)

• Attend programs and/activities when available

Connecting Over the Phone • Reconnect with people you already know through a phone call or text message

• Volunteer for a friendly caller program

• Call a support line or community agencies

Connecting Virtually • Send emails to friends and family

• Connect with others via free apps and/or websites:

o Facebook – https://www.facebook.com/ o Skype – https://www.skype.com/en/get-skype/ o Zoom - https://zoom.us/

• Check if your place of worship offers virtual services

This week I will connect with __________________by ______________________.

Appendix B

Sample Outcome Measures

Coping with COVID-19: Pre-Group Survey

Name: ________________________ Date: _________________________

Please respond to the following statements (Check the box):

Never Rarely Sometimes Usually Always

I am satisfied with my daily routine.

I am satisfied with my ability to take

care of myself (mentally, physically,

emotionally and/or spiritually).

I have experiences that bring me

happiness and joy.

I am satisfied with my friendships and

relationships.

I can cope with the changes in my

everyday life related to the

coronavirus pandemic.

Coping with COVID-19: Post-Group Survey

Name: ________________________ Date: _________________________

Please respond to the following statements (Check the box):

Never Rarely Sometimes Usually Always

I am satisfied with my daily routine.

I am satisfied with my ability to take

care of myself (mentally, physically,

emotionally and/or spiritually).

I have experiences that bring me

happiness and joy.

I am satisfied with my friendships and

relationships.

I can cope with the changes in my

everyday life related to the

coronavirus pandemic.

Coping with COVID-19: Post Program Survey

Did you learn any new strategies in this program? If yes, state which one.

___________________________________________________________________

___________________________________________________________________

__________________________________________________________________

Will you use any strategies you learned in this program in the future? (Circle One)

Definitely Probably Maybe Probably Not Definitely Not

What did you enjoy most about this program?

___________________________________________________________________

___________________________________________________________________

__________________________________________________________________

What could have been better?

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Appendix C

Sample Resource Package

Coping with COVID-19: Community Resource List

Home Safety Safety at Home Program – St. Joseph’s Homecare

• Free individualized home assessment with a summary of recommendations promoting independence and mobility

• Referral to other services • Support for accessing and installing equipment such as grab bars • Available to all Hamilton residents over 55 • To self-refer, contact by phone or email

o Phone: 905-522-6887 ext. 2237 o Email: smatinyarare@stjhc.ca

Home Maintenance Program – St. Joseph’s Homecare

Clients must be 60 years of age or older to be eligible for this service. Service available:

• Minor plumbing, electrical, and carpentry • Heavy cleaning including fridge and stove • Organizing closets, basements, and garages • Help to get ready for a move or downsizing • Contact:

o Phone: 905-522-6887 ext. 2252 o Email: akenderic@stjhc.ca

First Place Pharmacy (117-350 King St. East, Hamilton, ON L8N 3Y3)

• Bathroom equipment (raised toilet seat, bath bench, and much more!) • Adaptive equipment (sock aid, reacher, etc.) • Mobility aids (walkers, canes, etc.) • Hours:

o Monday-Friday - 9:00-6:00 o Saturday - 10:00-4:00 o Sunday - Closed

• Contact by phone or visit in person (don't forget to wear a mask!) o Phone: 905-845-8999

Food Programs First Place Food Cupboard (Main Lobby, 360 King St E, Hamilton, ON L8N 3Y3)

• Monday 9:00-12:00 • Wednesday 1:00-4:00

St Matthew’s House Emergency Food Program

• Phone: 905-523-5546 ext.240

• Email: admin@stmatthewshouse.ca

Volunteer Opportunities Catholic Family Services of Hamilton

The Socially Isolated Seniors Support Program is looking for peer volunteers! • The Seniors volunteer program is a social support network for seniors by

seniors. Seniors are given the opportunity to talk by telephone with volunteers in their own age group who are trained in informal counselling, effective listening, communications and problem-solving skills, exploring alternatives, the referral process and community resource.

• Requirements: o Volunteers must be 50+, provide weekly phone contact to assist seniors

60+ in our community by providing guidance, assisting in connecting with appropriate resources and non-professional counselling on a one to one basis

o Commit approximately 2-3 hours per week for this position • Training provided • Contact: 905-527-3823 ext. 279 • Website: https://www.cfshw.com/senior-volunteer-opportunities

Mental Health & Social Isolation Talk 2 Nice (non-crisis phone line)

• A free and friendly outreach support line that offers brief counselling services for older adults and persons with disabilities.

• To contact: o Phone: 1-844-529-7292 (Available 10AM-10PM) o Request a phone call for yourself or someone you know:

http://www.nicenet.ca/talk2nice

A Friendly Voice (non-crisis phone line)

• Trained volunteers provide empathetic support to seniors who may be feeling lonely or isolated.

• Phone: 1-855-892-9992

Crisis Outreach and Support Team (COAST)

• Mental Health Crisis Line • Available 24/7 - may not be able to answer every call, leave a message or

try again in 10 minutes • Phone: 905-972-8338 • If you or someone else is in immediate risk of serious harm, call 911

Activities & Recreation Senior’s Centre Without Walls

The Seniors’ Centre Without Walls provides free recreational activities over the phone with a group of other older adults in the community. SCWW allows participants to socialize and join in on Trivia, Family Feud, Finish the Lyrics, Brain Games and Fitness Classes, all over the phone for free.

• Programs are multi-person phone conversations (or conference calls). • No special equipment needed – any phone will do! • Call yourself in to the program, or we can call you – it’s your choice! • Each phone session averages 8-10 people on the call • You can hear each other, talk to one another, learn, and/or just have fun!

To register: • Phone: 905-973-0891 • Email: scww@hamilton.ca

• More information: https://www.hamilton.ca/recreation/seniors-centre-without-walls

Health Care

Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN)

Provides home and community health care services covered by OHIP, including: • Occupational Therapy • Physical Therapy • Nursing

• Personal care • Social work • Information and referrals

You can self-refer to the LHIN and will be connected with a Care Coordinator who will help determine your needs. Alternatively, your Tenant Support Worker, family doctor, or a family member can refer you to the LHIN.

• To self-refer, contact: o Phone: 1-800-810-0000 (open between 8:30 AM-8:30 PM) o State that you are self-referring for community services and explain

your concerns Health Care Connect

Free service to connect Ontario residents with a primary health care provider (a doctor or nurse practitioner). To Register:

• By phone: 1-800-445-1822 (9AM-5PM Monday-Friday) • Online:

https://hcc3.hcc.moh.gov.on.ca/HCCWeb/faces/layoutHCCSplash.jsp